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Adipose man  with newly diagnosed type 2 diabetes

Isabel  Schuil ,  Guilia   Ettl  &   Mariam Shabana Technische  Universität München Fakultät   für  Sport- und  Gesundheitswissenschaften   Lehrstuhl   für   Bewegung ,  Ernährung  und Gesundheit  München, 12.07.2021

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Ernährungsplanung  – nutrition for health

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Diet Omnivore Sweet tooth, high carb snacks all day ( e.g  bakeries) high carb, high fat, low protein diet  no understanding of macros in food & their significance beverages: 1l soft-drink daily, alcohol on weekends always picking up food “on the go”  big meal late in the evening  Routine profession: lawyer (sitting in office all day) activity level: no activity (drives car, no sports or outdoor activities) sedentary: 7h (adequate sleep) smoker  Symptoms glucosuria weakness, fatigue  increased thirst Anamnesis father had diabetes as well

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patient’s desire overall: increase quality of life primary goal: maintain normal range blood sugar levels weight loss to manage diabetes  increase physical activity the plan diet plan monitoring & guidance for 12 months goal: illness management through lifestyle changes  focus on fat loss & muscle gain for better physiological health no major restrictions in food &drinks under the disease’s dietary requirements decrease in carb & fat intake | increase in protein intake caloric deficit  philosophy: “everything in moderation”  introducing moderate physical activity to daily routine, as well as exercise

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key components for diabetes management 1. nutrition therapy healthy eating pattern, emphasizing a variety of nutrient dense foods in appropriate portions attaining glycemic goals & maintaining normal blood pressure, cholesterol, lipid & HbA1c levels 2. regular physical activity 3. pharmacotherapy if necessary  4. education & self-management nutrition counseling, monitoring & evaluation           long-term lifestyle changes

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Our  nutrional  & lifestyle advice for the patient

reduced energy intake for weight loss important factor in glycemic control: quantity & type of carbohydrates  carb intake from vegetables, fruits, legumes, whole grains & dairy products  >  carb intake from other sources that contain fats, sugars & sodium  fat quality  >  fat quantity              poly- & monounsaturated fats  >  saturated fats  >  trans fats increase protein intake to 1,5-2g/kg for decrease in hemoglobin through increased insulin response & other benefits (select lean protein sources &  meat alternatives) consumption of daily recommended amounts of micronutrients & dietary fiber from natural food sources ( e.g  min 38g /day fiber for adult men) Mediterranean-style diet  to improve glycemic control & cardiovascular risk factors in T2D patients low glycemic food  >  high glycemic foods limit alcohol consumption to two drinks per day for adult men, ideally less

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Day 1: caloric deficit & diabetes management Breakfast: Yogurt Bowl & cheese toast

ingredients amount kcal protein carbs fats Dietary fiber Skyr  vanilla yogurt 250g 134 22g 10,20g 0,60g - blueberries 100g 57 0,74g 14,5g 0,33g 2,4g raspberries 100g 52 1,2g 12g 0,65g 6,5g Sliced almonds 20g 116 2,4g 6,24g 9g 2,6g Oat bran 20g 68 3g 9,2g 1,4g 1,6g Rye bread  slice (56g) 143 4,6g 22,4g 3,1g 3,6g Cottage cheese 2tbsp 30 3,6g 0,77g 1,3g - total 600 kcal 37,54g 75,31g 16,75g 16,7g

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Day 1: caloric deficit & diabetes management Lunch: Tuna salad

ingredient amount kcal protein carbs fats dietary fiber Mixed salad With dressing 2tbsp 88 1,54g 6,64g 6,74g 2g tuna 200g 216 46,76g - 1,90g - Tricolor quinoa  1/4cup (43g) 160 6g 28g 2,50g 3g Chickpeas, boiled 40g 36,70 2g 6,30g 0,60g 3,04g Kidney beans 50g 55 3,75g 7,50g 0,25g 12,5g avocado one 322 4,02g 17,15g 29,50g 13,50g Pumpkin seeds 10g 58,5g 3,40g 0,80g 4,50g 5g Black olives 1 portion (10) 36 0,30g 2,06g 3,24g 1g Dark chocolate (80%) 10g 60 0,94g 2,47g 4,93g 1,23g total 1032 kcal 68,7g 70,92g 54,20g 38,23g

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Day 1: caloric deficit & diabetes management Dinner: Tex-Mex Pasta

ingredient amount kcal protein carbs fat dietary fiber Whole wheat pasta  85g 296 12,40g 63,80g 1,20g - mushrooms 100g 22 3,10g 3,28g 0,34g 1g Mixed bell peppers 200g 52 2g 12g 0,60g 4g Red onions 50g 21 0,50g 5,55g 0,04g 1,40g Tomatoes (diced) 2 medium 44 2,16g 9,64g 0,50g 1,50g Baby spinach 200g 46 5,72g 7,26g 0,78g 4,4g Zucchini 200g 40 4g 4,5g 0,60g 2g Jalapeno peppers 1 pepper 4 0,19g 0,83g 0,09g 0,40g Skinless chicken breast 150g 165 34,65g - 1,86g - Olive oil 2tsp 80 - - 9g - garlic One clove 4 0,20g 1g 0,02g 0,1g Salt, pepper, spices  total 774 kcal 64,86g 107,9g 15,03g 14,8g

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Day 1: caloric deficit & diabetes management Snacks

ingredients amount kcal protein carbs fat Dietary fiber Mixed nuts 30g 170 6g 5g 15g 2g strawberries 200g 64 1,4g 15,4g 0,6g 4g total 234 kcal 7,4g 20,4g 15,6g 6g Daily total 2640 kcal 178,5g 274,53g 101,58g 75.73g

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Hamdy  O, Horton ES. Protein content in diabetes nutrition plan.  Curr  Diab Rep. 2011 Apr;11(2):111-9.  doi : 10.1007/s11892-010-0171-x. PMID: 21207203. Recommendations for the nutritional management of patients with diabetes mellitus. (2000). European journal of clinical nutrition, 54 (4), 353 –355. https:// doi.org /10.1038/sj.ejcn.1600962 Recommendations for the nutritional management of patients with diabetes mellitus. Eur J Clin  Nutr . 2000 Apr;54 (4):353-5.  doi :  10.1038/sj.ejcn.1600962. PMID: 10747363. Edelman SV. Type II diabetes mellitus. Adv Intern Med. 1998;43:449-500. PMID: 9506190. Tan JWC, Sim D,  Ako  J, et al. Consensus Recommendations by the Asian Pacific Society of Cardiology: Optimising Cardiovascular Outcomes in Patients with Type 2 Diabetes. Eur  Cardiol . 2021;16:e14. Published 2021 Apr 19. doi:10.15420/ecr.2020.52 Deutsche Gesellschaft  für   Ernährung   e.V . (2021).  Mittelmeer-Diät   wirkt   bei  Diabetes mellitus  Typ  2  besonders   günstig . https:// www.dge.de / ernaehrungspraxis / diaetetik /diabetes-mellitus/ mittelmeer - diaet -diabetes/ Hauner , H. (2016). Essen und  Trinken   bei  Diabetes mellitus.  Institut   für   Ernährungsmedizin ,  Klinikum   rechts  der  Isar , TU München. https:// www.mri.tum.de /sites/default/files/seiten/essen_und_trinken_bei_diabetes_mellitus_maerz_2016.pdf Kim, M. K., Ko, S. H., Kim, B. Y., Kang, E. S., Noh, J., Kim, S. K., Park, S. O.,  Hur , K. Y., Chon, S., Moon, M. K., Kim, N. H., Kim, S. Y., Rhee, S. Y., Lee, K. W., Kim, J. H., Rhee, E. J., Chun, S., Yu, S. H., Kim, D. J., . . . Park, K. S. (2019). 2019 Clinical Practice Guidelines for Type 2 Diabetes Mellitus in Korea. Diabetes & Metabolism Journal, 43(4), 398–406. https:// doi.org /10.4093/dmj.2019.0137    Marín- Peñalver , J. J., Martín- Timón , I.,  Sevillano-Collantes , C., & Del  Cañizo -Gómez, F. J. (2016). Update on the treatment of type 2 diabetes mellitus. World Journal of Diabetes, 7(17), 354–395. https:// doi.org /10.4239/wjd.v7.i17.354   Nationale   VersorgungsLeitlinie . (2015).  Therapie  des Typ-2-Diabetes [ PatientenLeitlinie   zur   Nationalen   VersorgungsLeitlinie  „ Therapie  des Typ-2-Diabetes"].  Bundesärztekammer ;  Kassenärztliche   Bundesvereinigung ;  Arbeitsgemeinschaft  der  Wissenschaftlichen   Medizinischen   Fachgesellschaften . Pfeiffer, A.,  Gebauer , S., Rubin, D., Schulze, M., Buchholz, G., Klein, H., Lilienfeld- Toal , H. von, Reinert, G., Simon, M.,  Müssig , K.,  Skurk , T.,  Hauner , H.,  Tombek , A., Müller, M., Fischer, S.,  Weickert , M., & Hoffmann, D. (2016).  Ernährungsempfehlungen   zur   Behandlung  des Diabetes mellitus –  Empfehlungen   zur   Proteinzufuhr .  Diabetologie  Und  Stoffwechsel , 11(04), 272–282. https:// doi.org /10.1055/s-0042-111088   Schwingshackl , L.,  Chaimani , A., Hoffmann, G.,  Schwedhelm , C., & Boeing, H. (2017). A network meta-analysis on the comparative efficacy of different dietary approaches on  glycaemic  control in patients with type 2 diabetes mellitus. European Journal of Epidemiology.   https://www.semanticscholar.org/paper/A-network-meta-analysis-on-the-comparative-efficacy-Schwingshackl-Chaimani/6baaed75f80e0e555878e6eb322f772e737ec982 https://www.fda.gov/media/99203/download https://www.who.int/news-room/fact-sheets/detail/healthy-diet


Adipose man 
with newly diagnosed type 2 diabetes


 Hamdy  O, Horton ES. Protein content in diabetes nutrition plan.  Curr  Diab Rep. 2011 Apr;11(2):111-9.  doi : 10.1007/s11892-010-0171-x. PMID: 21207203. Recommendations for the nutritional management of patients with diabetes mellitus. (2000). European journal of clinical nutrition, 54 (4), 353 –355. https:// doi.org /10.1038/sj.ejcn.1600962 Recommendations for the nutritional management of patients with diabetes mellitus. Eur J Clin  Nutr . 2000 Apr;54 (4):353-5.  doi :  10.1038/sj.ejcn.1600962. PMID: 10747363. Edelman SV. Type II diabetes mellitus. Adv Intern Med. 1998;43:449-500. PMID: 9506190. Tan JWC, Sim D,  Ako  J, et al. Consensus Recommendations by the Asian Pacific Society of Cardiology: Optimising Cardiovascular Outcomes in Patients with Type 2 Diabetes. Eur  Cardiol . 2021;16:e14. Published 2021 Apr 19. doi:10.15420/ecr.2020.52 Deutsche Gesellschaft  für   Ernährung   e.V . (2021).  Mittelmeer-Diät   wirkt   bei  Diabetes mellitus  Typ  2  besonders   günstig . https:// www.dge.de / ernaehrungspraxis / diaetetik /diabetes-mellitus/ mittelmeer - diaet -diabetes/ Hauner , H. (2016). Essen und  Trinken   bei  Diabetes mellitus.  Institut   für   Ernährungsmedizin ,  Klinikum   rechts  der  Isar , TU München. https:// www.mri.tum.de /sites/default/files/seiten/essen_und_trinken_bei_diabetes_mellitus_maerz_2016.pdf Kim, M. K., Ko, S. H., Kim, B. Y., Kang, E. S., Noh, J., Kim, S. K., Park, S. O.,  Hur , K. Y., Chon, S., Moon, M. K., Kim, N. H., Kim, S. Y., Rhee, S. Y., Lee, K. W., Kim, J. H., Rhee, E. J., Chun, S., Yu, S. H., Kim, D. J., . . . Park, K. S. (2019). 2019 Clinical Practice Guidelines for Type 2 Diabetes Mellitus in Korea. Diabetes & Metabolism Journal, 43(4), 398–406. https:// doi.org /10.4093/dmj.2019.0137    Marín- Peñalver , J. J., Martín- Timón , I.,  Sevillano-Collantes , C., & Del  Cañizo -Gómez, F. J. (2016). Update on the treatment of type 2 diabetes mellitus. World Journal of Diabetes, 7(17), 354–395. https:// doi.org /10.4239/wjd.v7.i17.354   Nationale   VersorgungsLeitlinie . (2015).  Therapie  des Typ-2-Diabetes [ PatientenLeitlinie   zur   Nationalen   VersorgungsLeitlinie  „ Therapie  des Typ-2-Diabetes"].  Bundesärztekammer ;  Kassenärztliche   Bundesvereinigung ;  Arbeitsgemeinschaft  der  Wissenschaftlichen   Medizinischen   Fachgesellschaften . Pfeiffer, A.,  Gebauer , S., Rubin, D., Schulze, M., Buchholz, G., Klein, H., Lilienfeld- Toal , H. von, Reinert, G., Simon, M.,  Müssig , K.,  Skurk , T.,  Hauner , H.,  Tombek , A., Müller, M., Fischer, S.,  Weickert , M., & Hoffmann, D. (2016).  Ernährungsempfehlungen   zur   Behandlung  des Diabetes mellitus –  Empfehlungen   zur   Proteinzufuhr .  Diabetologie  Und  Stoffwechsel , 11(04), 272–282. https:// doi.org /10.1055/s-0042-111088   Schwingshackl , L.,  Chaimani , A., Hoffmann, G.,  Schwedhelm , C., & Boeing, H. (2017). A network meta-analysis on the comparative efficacy of different dietary approaches on  glycaemic  control in patients with type 2 diabetes mellitus. European Journal of Epidemiology.   https://www.semanticscholar.org/paper/A-network-meta-analysis-on-the-comparative-efficacy-Schwingshackl-Chaimani/6baaed75f80e0e555878e6eb322f772e737ec982 https://www.fda.gov/media/99203/download https://www.who.int/news-room/fact-sheets/detail/healthy-diet

Adipose man with newly diagnosed type 2 diabetes

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